Cardiology Requirements for PACS

Defining Future Needs

The Robert Bosch Krankenhaus was opened in 1973 and has created
a worldwide reputation in medical and surgical care, for pioneering the
practical application of innovative IT solutions to improve healthcare delivery.
In my position as "Oberarzt", a function that is somewhere between
consultant and registrar, I am responsible for our ten-bed intensive care unit,
in particular our Cardiac Magnetic Resonance (CMR) unit, which performs 1,500
CMR procedures each year. CMR imaging has emerged as a new non-invasive imaging
modality providing high-resolution images of the heart in any desired plane. In
our department we have 80 beds, operate three echography machines, one magnetic
resonance and two angiography units. We perform 3,500 coronary angiographies,
1,500 percutaneous transluminal coronary angioplasty (PTCA) interventions, and
over 6,500 echocardiographies on an annual basis.

Current PACS in our Department

The
leading system, as in most medical facilities, is the Hospital Information
System (HIS). Our current HIS is made by ISOFT. This enables us to have one
convenient front-end for patient history, images and all other patient data,
avoiding time loss in searching for one patient through different systems. While
it is of core importance that cardiology PACS should be enterprise-wide and
integrated, presently we have a separate PAC system in our department for
echography, angiography and CMR and use a blend of service providers to meet
our needs.

We
also have a local echography PACS with three echography machines and a
workstation. Using this set-up, images can only be reviewed at the workstation.
Our webbased CMR PACS, in use since four years ago, is made by HeartIT. Images
can be reviewed on all PCs in the hospital. For echography we use GE Vingmed
solutions with a workstation using a system called ECHO-PAC. For angiography,
we have local workstations but not a real PACS, using two Siemens cath-labs
with local workstations from Siemens. For radiology our hospital has been using
a PACS for the last two years made by Image Devices.

Benefits of Integrated Cardiology PACS

The
benefits of integrated PACS in cardiology departments, surprisingly, has little
to do with gains in time, which are onlymarginal. Recently, as part of
our drive to re-evaluate our current system, a consultant assessed possible
improvements in real terms. What he found was that while gains of time are only
marginal, the improvement in image quality may be considerable and is certainly
enough to make an integrated system an essential addition. The main vendors of
cardiology PACS on the European scene for stand-alone solutions presently, are
GE, Philips and Siemens. For integrated solutions Agfa and Medcon (McKesson)
are proving to be leading providers, while in the future HeartIT, Witt working
in partnership with Philips, and of course Agfa are shaping up to take the pole
positions.

The
presence of a comprehensive support solution is a vital part of our decision.
In our own case, final decisions on which vendor to purchase new IT solutions
from are made by both management and staff, and our chosen vendor must provide
back-up consultation services. Future IT upgrades for our department’s cardiology
PACS, will be based on the need for a web-based system, which can be used on
every PC in the hospital to view all cardio exams. The other main criteria is
speed as well as image quality.

An Integrated Approach

With
systems of the future, the electronic health record will enable referring
physicians to view their patient’s cardiology studies in an integrated and
accessible way. Currently with CMR, we are able to give every outpatient a CD
with exam results stored on it. In the future we hope to develop a more comprehensive
IT solution for the d department that sees it integrated with the HIS rather
than as a stand-alone system. Deploying this kind of holistic approach is
tricky, not least because although DICOM is an invaluable protocol for the transmission
of image data, the proprietary formats such as for echography are an obstacle
to a wholly integrated solution. That is why most vendors of cardiology PACS enable
sending of images not in DICOM but as mpg4 or animated .gif files. No vendor
with pure DICOM viewers can be fast enough.

Challenges Particular to Cardiology PACS

Cardiology
departments in hospitals have been far slower to adopt PACS than radiology,
purely because there are by necessity far more images and data produced per
case. Also, the multimodality nature of cardiology brings specific challenges
in synchronising information on a PACS. For example, until two years ago it was
not possible to convert our echo loops into DICOM. ECG has yet another format
and is difficult to store. Of course there are technical differences in
requirements between radiology and cardiology PACS, particularly in the
different front-end systems needed in each case. The absolute basic IT
infrastructure I consider essential for a department considering purchasing a
cardiology PACS, is a deep archive with a long- and short-term storage, PCs and
a 100MB net.

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